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kDDRESS OR LOCATION: UJ APN- <br /> JNER:—cw,,-tQ L-n iA ILL �- w� -N, 1" DATE: <br /> —PLICATION #r: DEPTH TO FIRST WATER: ft SOIL TYPE: <br /> 2tzMARKS: <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES <br /> t tE i <br /> ri nk-11 OA <br /> L PROFILE (IF REQUIRED) <br /> Soil Type Depth Soil pe Depth Soil Type E !:i i <br /> ethf Depth Soil Type <br /> FST HOLE-r"rl DIAMETER: � in DEPTH: ift TEST HOLE#2 DIAMETER: in DEPTH: in <br /> WATER F <br /> W"ATERTiNE READING DROP raTILLED TIME READING DRop <br /> REFILLED <br /> 1 :5 J <br /> -Z Z <br /> 14.W b.cZ 5 T2 ,0 <br /> C)C) <br /> 1-7. 55 DA6 761 ,5, 70 0 w I yi I <br /> 1i I o 14— <br /> da <br /> 1 t5 <br /> 01 00 <br /> PvRCOLATION RATE: min/in PERCOLATION RATE: Ct lo"P�Oei "n/in <br /> RFCONLTVIENDEI)SEPTIC AREA: <br /> h> COMMENDEDSEPTIC AREA: <br /> UMED BY: Phone: <br /> ST PERFOP Date <br /> TEST CERTIFIED BY: Phone: Date <br /> ;SERVED,BY(RENS): Phone Date <br /> 17PI)42-02-003 PERC TEST RATE FORMIc <br /> I VISED 517102 <br />